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Wildfire Smoke More Dangerous Than Other Air Pollution for People With Asthma
Stage 2 Air Quality Index and alarming research studies from DRI, Renown Health and the Washoe County Health District leads to public health advisory- seek care if needed For people who suffer from asthma, wildfire smoke is more hazardous than other types of air pollution, according to a study from the Desert Research Institute (DRI), the Renown Institute for Health Innovation (Renown IHI) and the Washoe County Health District (WCHD). The study published in the journal Environmental Health examined associations between airborne particulate matter (PM) from sources such as wildfire, transportation and industry, and medical visits for asthma at Renown Health’s emergency departments and urgent care centers in Reno, Nev. during the six-year period from 2013-2018. In places like Reno, where wildfire events occur regularly during parts of the year and are expected to become more frequent in the future, an accurate understanding of the impacts of wildfire smoke on population health is critical. We have an exceptional process in place through our urgent care sites, Renown Medical Group offices and hospital emergency departments to screen, diagnose and treat members of our community who come to us for care related to asthma, chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, and other upper respiratory diseases that may be exacerbated by wildfire smoke. At the same time, we continue to develop and refine, in real-time, the data that supports our predictive analytic models. We are using every tool and resource-including scientific data and clinical reporting, to ensure that we are meeting both the health and healthcare needs of the people we serve. In the study, researchers found that air quality in the Reno area was affected by wildfire smoke on a total of 188 days during the study period. A total of 18,836 asthma-related emergency room and urgent care visits occurred over the same five-year period of time, indicating that the influences of wildfire smoke and other types of air pollution on this medical condition are important to understand. The Washoe County Health District – Air Quality Management Division (AQMD) has issued a Stage 2 Air Pollution Warning due to smoke from area wildfires. Air quality in the Reno-Sparks area is now “Very Unhealthy” with an Air Quality Index of 247. The Stage 2 warning means that all residents should stay indoors and reduce activity levels due to the susceptibility of increased health risks. To see current air quality in Reno-Sparks, click here. Brion Hill, MD who practices at the Renown Urgent Care - Los Altos location warns, “This is an important health advisory, exposure to elevated PM2.5 (fine particulate matter in smoke) concentrations can result in eye and throat irritation, headaches, nausea, shortness of breath, congestion, coughing, impaired lung function and chest pain. Everyone should take precautions when the air quality is unhealthy. Air pollution can aggravate heart and cardiovascular disease as well as lung diseases like asthma and COPD. When the air quality is unhealthy, people with these conditions may experience symptoms like chest pain, shortness of breath, wheezing, coughing, or fatigue. If you are experiencing any of these symptoms, use your inhalers as directed and contact your health care provider,” says Dr. Hill. “If you do not have a health care provider, we have 11 conveniently located Renown Urgent Care offices with providers ready to see you 7 days a week." Dr. Joseph Grzymski, a research professor at Desert Research Institute, a corresponding author on the study and Chief Scientific Officer, Renown Health, says, “This air is very bad for your health. Given today’s Air Quality Index in Reno, being outside and breathing this air for a day equals about smoking half a package of cigarettes.” Additional Information: The full text of the article “Particulate matter and emergency visits for asthma: a time-series study of their association in the presence and absence of wildfire smoke in Reno, Nevada, 2013–2018,” is available from Environmental Health: https://ehjournal.biomedcentral.com/articles/10.1186/s12940-020-00646-2 To learn more about the Renown Institute for Health Innovation, please visit: https://www.dri.edu/renown-ihi/ Renown Urgent Care provides treatment for a wide range of minor injuries, illnesses and medical concerns that are urgent but not life-threatening, that require same-day medical attention and avoid the long wait times and high prices of the emergency room at 13 convenient sites, including Reno, Sparks, Carson City, USA Parkway, Fallon and Fernley. You can walk-in or book ahead online. The Washoe County Health District offers online health information on its Be Smoke Smart website, including fire information, daily air quality information, fire and smoke maps and how to protect yourself. About the Desert Research Institute The Desert Research Institute (DRI) is a recognized world leader in basic and applied interdisciplinary research. Committed to scientific excellence and integrity, DRI faculty, students, and staff have developed scientific knowledge and innovative technologies in research projects around the globe. Since 1959, DRI’s research has advanced scientific knowledge, supported Nevada’s diversifying economy, provided science-based educational opportunities, and informed policymakers, business leaders, and community members. With campuses in Reno and Las Vegas, DRI serves as the non-profit research arm of the Nevada System of Higher Education. For more information, visit www.dri.edu. About Renown Health Renown Health is a locally governed, not-for-profit integrated healthcare network serving northern Nevada, Lake Tahoe and northeast California. Renown is one of the region’s largest private employers with a workforce of more than 7,000. It comprises three acute care hospitals, a rehabilitation hospital, the area’s most comprehensive medical group and urgent care network, and the region’s largest and only locally owned not-for-profit insurance company, Hometown Health. Renown has a long tradition and commitment to improve the care and the health of our community. For more information, visit renown.org.
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Where There is Smoke; There May Be More Headaches, Nausea and Coughing
Renown Urgent Care team prepares you to stay safe this season and is available seven days a week at 11 locations across northern Nevada Millions of people across the West live in areas where air pollution can cause serious health problems. Local air quality can affect our daily lives. Like the weather, it can change from day to day. The Northern Sierra Air Quality Management District issued an Air Quality Health Advisory for Plumas County, to notify the public of the possibility of poor air quality conditions resulting from the Beckwourth Complex Fire in addition to other wildfires in northern California. In addition, there is the potential for wind shifts to carry smoke to other parts of Plumas County from the Beckwourth and several other regional wildfires. Air quality is expected to vary greatly depending on fire behavior and weather conditions, with smoke settling in low areas at night and in the early mornings as long as these fires are active. The advisory mentions, “Exposure to elevated PM2.5 (fine particulate matter in smoke) concentrations can result in eye and throat irritation, headaches, nausea, shortness of breath, congestion, coughing, impaired lung function and chest pain, especially among sensitive individuals such as the elderly, children, people with asthma, people with heart or lung conditions, pregnant women and anyone who is exercising or working hard outdoors.” Kouros Farro, MD, a physician with Renown Urgent Care advises that there are people who are more likely to be affected when fine particle pollution reaches an unhealthy level. People who have asthma or other breathing conditions like chronic obstructive pulmonary disease (COPD). People who have heart disease or high blood pressure. Children and older adults. People of all ages who are doing extended or heavy, physical activity like playing sports or working outdoors. “Everyone should take precautions when the air quality is unhealthy. Air pollution can aggravate heart and cardiovascular disease as well as lung diseases like asthma and COPD. When the air quality is unhealthy, people with these conditions may experience symptoms like chest pain, shortness of breath, wheezing, coughing, or fatigue. If you are experiencing any of these symptoms, use your inhalers as directed and contact your health care provider,” says Dr. Farro, who is board certified in family medicine and practices at Renown Urgent Care at 975 Ryland St in Reno. “If you do not have a health care provider, know we have a Renown Urgent Care office on almost every corner, with providers ready to see you.” Dr. Farro advises the following: Take it easy and listen to your body. Limit, change, or postpone your physical activity level. If possible, stay away from local sources of air pollution like busy roads and wood fires. If you have asthma or other breathing conditions like COPD make sure you have your relief/rescue inhaler with you. People with asthma should review and follow guidance in their written asthma action plan. Make an appointment to see your health provider to be sure you have an asthma action plan. “Even just one hour of smoke exposure can affect our lungs and hearts, and these consequences can reach people far beyond the direct area endangered by the fire. Children, older adults, pregnant women, people with preexisting cardiopulmonary disease, communities of color, economically disadvantaged communities, and people with preexisting chronic health conditions like asthma, diabetes, and obesity are all especially vulnerable to the air pollution that wildfires cause," says Dr. David Lemak, Division Chief of Urgent Care at Renown. Renown Urgent Care provides treatment for a wide range of minor injuries, illnesses and medical concerns that are urgent but not life-threatening, that require same-day medical attention and avoid the long wait times and high prices of the emergency room at 11 convenient sites, including Reno, Sparks, Carson City, USA Parkway, Fallon and Fernley. You can walk-in or book ahead online. You can get the latest fire and smoke information at the Washoe County Health District’s Be Smoke Smart webpage. It includes information about air pollution levels and how to protect yourself from the smoke. An on-line subscription page allows you to sign up for EnviroFlash, notifying you about air quality. About Renown Health Renown Health is a locally governed, not-for-profit integrated healthcare network serving northern Nevada, Lake Tahoe and northeast California. Renown is one of the region’s largest private employers with a workforce of more than 7,000. It comprises three acute care hospitals, a rehabilitation hospital, the area’s most comprehensive medical group and urgent care network, and the region’s largest and only locally owned not-for-profit insurance company, Hometown Health. Renown has a long tradition and commitment to continually improve the care and the health of our community. For more information, visit renown.org.
Read More About Where There is Smoke; There May Be More Headaches, Nausea and Coughing
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Pulmonary and Sleep Medicine
Pulmonary Medicine Our expert pulmonary medicine team diagnoses and cares for patients with lung and breathing challenges. Serious breathing problems and long-term conditions, such as COPD and emphysema, are treated by our extensively trained providers. Our board-certified care team has the experience and clinical judgment to ensure the strongest possible patient outcomes. If you have a chronic lung condition diagnosis, you may also benefit from Renown Pulmonary Rehab. Conditions We Treat Asthma Bronchitis (acute and chronic) Chest infections Chronic obstructive pulmonary disease (COPD) Cystic fibrosis Emphysema Lung cancer Lung transplant Pulmonary fibrosis Pulmonary hypertension Pulmonary tuberculosis (TB) Other chronic lung diseases Pulmonary Services
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Stay Inside When Skies Are Smoky
Even when fires burn outside our area, the air quality in the region can reach dangerous levels. Our expert explains how to maintain your lung health when fire season strikes. It’s a sight we know all too well as northern Nevadans — a hazy or thick layer on the horizon when smoke rolls in from nearby fires. Sometimes the smoke is more evident than others, but it’s important to remember, even when the smoke may not be as visible across the valley, it still impacts our air quality. The last week or so, our air quality has been in the “unhealthy for sensitive groups” range, which can be dangerous for people who are sensitive to air pollution. Air Quality Changes: Who’s at Risk? Renown Pediatric Pulmonologist Sonia Budhecha, M.D., explains certain people are especially at risk when smoke moves in: Older people, whose lungs are not as healthy as they used to be Young children, whose lungs are still developing People with heart and lung disease including asthma, COPD and emphysema “Smoke and haze from fires carry particulates that can get into your respiratory system and eyes, which can be a danger for all ages,” Dr. Budhecha says. How You Can Protect Yourself Until the smoke clears and the air returns to the “good” range, it is best to follow these tips to protect yourself and your family: Stay indoors and keep windows closed Turn on the air conditioning to recirculate clean air Drink plenty of fluids to help your body flush out any toxins you inhale Additionally, all community members should reduce their physical activity and try to prevent heavy exertion outside. If you or a loved one has a heart or lung disease, avoid physical exertion altogether because smoke can aggravate these conditions. “People with heart disease may experience shortness of breath, chest pain, palpitations or fatigue,” Dr. Budhecha says. “People with lung disease may also have shortness of breath, chest discomfort, wheezing, phlegm or a cough.” Smoky Signs and Symptoms Smoke can also impact healthy people — irritating your eyes, nose or throat. And in some cases, inhaling smoke can lead to bronchitis. When haze moves into our area, keep an eye out for these symptoms: Burning or stinging eyes Runny nose Cough or scratchy throat Headaches Wheezing Shortness of breath Difficult taking a full breath Chest heaviness Lightheadedness Dizziness If experiencing any of the above symptoms, seek medical attention or call your doctor for advice. Sometimes, these symptoms do not appear for as long as 24 to 48 hours after smoke inhalation. For those that have pre-existing lung or heart conditions, consult with a health care provider on action or management plans. To schedule an appointment Visit Renown Pulmonary Medicine, or call 775-982-5000. Understanding Our Air Quality The Air Quality Index (AQI) is broken down by large (PM10) and small (PM2.5) particulates. According to Dr. Budhecha, large particulates are usually ones that can be seen and smelled. They can damage your eyes and nose but don’t often get deep in the lungs or blood vessels. “The more dangerous ones are PM2.5, which can’t always be seen or smelled,” Dr. Budhecha says. “Any time the AQI is above 51, children with lung or heart disease should not be outdoors.” For the latest air quality update in your area, visit AirNow.gov or call (775) 785-4110.
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Tips for Coping with Smoke-Related Health Problems
Millions of people across the west live in areas where air pollution can cause serious health problems. In addition, local air quality can affect our daily lives. Who is Affected? Kouros Farro, MD, a physician with Renown Urgent Care, advises that certain people are more likely to be affected when fine particle pollution reaches an unhealthy level. People who have asthma or other breathing conditions like chronic obstructive pulmonary disease (COPD). People who have heart disease or high blood pressure. Children and older adults. People of all ages who are doing extended or heavy physical activity like playing sports or working outdoors. “Everyone should take precautions when the air quality is unhealthy. Air pollution can aggravate heart and cardiovascular disease as well as lung diseases like asthma and COPD. When the air quality is unhealthy, people with these conditions may experience symptoms like chest pain, shortness of breath, wheezing, coughing, or fatigue. If you are experiencing any of these symptoms, use your inhalers as directed and contact your health care provider,” says Dr. Farro, who is board certified in family medicine and practices at Renown Urgent Care at 975 Ryland St. in Reno. “If you do not have a health care provider, there is a Renown Urgent Care office on almost every corner, with providers ready to see you.” Dr. Farro advises the following: Take it easy and listen to your body. Limit, change or postpone your physical activity level. If possible, stay away from local sources of air pollution like busy roads and wood fires. If you have asthma or other breathing conditions like COPD, make sure you have your relief/rescue inhaler with you. People with asthma should review and follow the direction in their written asthma action plan. Make an appointment to see your health provider to be sure you have an asthma action plan. Getting Same-Day Care Renown Urgent Care provides same-day treatment for a wide range of minor injuries, illnesses and medical concerns that are urgent but not life-threatening. Avoid the long wait times and high emergency room prices at 11 convenient sites, including Reno, Sparks, Carson City, USA Parkway, Fallon and Fernley. You can walk in or book ahead online. Make an Urgent Care Appointment Community Health Resources The Washoe County Health District offers online health information on its Smoke Smart website, including fire information, daily air quality information, fire and smoke maps and how to protect yourself. In addition, an online subscription page allows you to sign up for EnviroFlash, notifying you about air quality.
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How to Manage and Prevent Tendonitis
Tendonitis occurs when a tendon in your body is inflamed or irritated. This painful condition can impact your day-to-day activities, but can be managed and prevented. Luis Palacio, MD, shared some insights into how to manage tendonitis. Overuse and Repetitive Motion Tendons are complex tissues in our body that connect muscles to bones, allowing us to move. Unfortunately, sometimes these tendons become inflamed, worn down or injured, a condition called tendonitis. Symptoms of tendonitis include pain or dull ache, tenderness and mild swelling at the site. While tendonitis can be caused by a sudden injury, it is more commonly seen in frequent motions, including: Repetitive motions in exercise, work or other physical activities. Awkward positions in a movement, including poor posture. Forced movements that strain your body. Sudden increase in frequency of movement or level of difficulty, including little to no recover time between new activity. Shoes without proper support or hard surfaces, such as concrete floors. Evaluation is Key If you suspect that you have tendonitis and it does not resolve on its own after a few days, you should get it evaluated by a primary care or sports medicine doctor. They can make recommendations to aid your recovery and refer you to the right sub-specialist if needed. With some intentional actions, you can help reduce the risk of tendonitis with the following suggestions: Add variety: Mixing up the type of exercise you do will help prevent repetitive motions that can result in overuse. Stretch and condition: Make sure the keep up with proper stretching and muscle strengthening to support your physical activities. Do it right: Make sure that the way you are completing exercise or work-related physical activities is correct. Seek out a professional for lessons or guidance if you are unsure.
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How to Treat a Sprain or Strain
Injuries happen to everyone. They are caused by participating in sports, recreational activities like hiking, and even by accidentally stepping off a curb wrong. If you experience a sprain or strain, the first few days are often the most painful. Renown Sports Medicine physicians Luis Palacio, MD and Brandon Hockenberry, MD walked us through what to do after an injury. Listen to Your Body See a medical professional right away if: You know or suspect that a bone is broken You are having difficulties putting full weight on a joint of the leg Pain or swelling is severe There is a sign of an infection, such as redness and warmth in the joint The First 24-72 Hours Joint sprains tend to swell more than muscle strains. You can use ice as needed for comfort and to relieve any pain, but do not use ice for more than 15-20 minutes at a time. Ice and NSAIDs (such as ibuprofen) can help prevent excessive swelling and mask the pain, but they do not speed recovery. Some research shows that overuse of ice actually delays recovery. During the first 24-72 hours, your injury will go through an inflammation phase. Inflammation is your body’s natural way to dispose of dead tissue cells, build new healthy structures, and hopefully heal even stronger than before.
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Understanding and Managing Childhood Asthma
Dr. Shipra Singh, a Pediatric Pulmonologist, outlines the challenges of diagnosing asthma in children due to symptoms resembling other respiratory issues. It's particularly difficult to identify in infants and young children, who may not clearly exhibit breathing difficulties. Asthma, often confused with bronchitis, croup, or allergies, is a significant chronic illness causing school absenteeism, as per the CDC. Risk factors include prenatal smoking and family history of allergies or asthma. Infants and toddlers are more susceptible due to smaller airways and respiratory viruses, which can exacerbate conditions like colds and bronchitis. How can I tell if my child has asthma? Unfortunately small children are unable to describe their symptoms, making asthma difficult to diagnose. Your child may even be active, playing and smiling, although they are experiencing chest tightness or labored breathing. Observe your child and let the child’s doctor know if: Your child’s breathing behavior has changed (coughing, wheezing, rapid breathing) Your child’s breathing pattern changes (day vs. night, with rest or activity, inside vs. outside) You have a family history of asthma or allergies Your child’s breathing is triggered by any foods or allergies With your help, your child’s doctor can make the best diagnosis to determine if your child has asthma. A pediatric pulmonologist (lung specialist) or pediatric allergist may also have to be consulted for special testing. Tests may include lung function testing, allergy tests, blood tests and X-rays for an accurate diagnosis. What is the treatment for infants and toddlers? Young children can use many of the same medications as older children and adults, although the way they take them and the dosage will differ. A nebulizer (or breathing machine) creating a medicated mist for your child to breathe through a mask may be used. An inhaler with a small spacer tube connected to a mask is also common to help your child breath medication into their lungs. Either of these options are effective. Asthma in children is treated with both fast-acting and long-term medicines to open up airways quickly for easy breathing and also to lessen asthma symptoms over time. Communicate with your child’s medical providers to create a personalized asthma management plan for them. How can I manage my child’s asthma? Recognize your child’s breathing habits and be aware of worsening symptoms. Consult with your child’s doctor on a daily asthma action plan to recognize worsening symptoms and track medications. Here’s an example of an asthma action plan provided by the U.S. Department of Health and Human Services’ National Institutes of Health). Be consistent with the plan and talk to your doctor before changing it. Have an emergency plan in case of a serious asthma attack. Know where the closest ER is and know who can take care of your other children. Also know what the medical treatment coverage is under your insurance plan. Dr. Singh explains, "Discussing asthma with your child may be difficult. Some kids find the subject frightening or confusing. Others, especially the older kids, may resent the treatment and may not be interested in doing it. Talk to your doctor about advice to build an open and trusting relationship regarding your child's asthma care."
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Department Spotlight: Special Procedures
Chronic pain can be one of the most distressing feelings someone may encounter – and more likely than not, you know someone who is managing their pain as a part of their healthcare journey. In fact, according to the Centers for Disease Control and Prevention, about 1 in 5 U.S. adults have experienced chronic pain in recent years. One of the most common methods of treating pain is through prescription pain medications; however, with the rise of the opioid epidemic across the country, leveraging other interventions to help patients manage their chronic pain has become increasingly more important. What if there was a way to treat pain directly without the automatic need for pain medication? Luckily for patients in northern Nevada, our Special Procedures department at Renown Rehabilitation Hospital specializes in exactly that: interventional pain mitigation sans painkillers. With nearly 95% of their patients who come in with pain-related mobility issues being able to physically walk out of the hospital after their treatment, much-needed relief is clearly in store. Tight-knit and forever-caring, the Special Procedures team knows how to transform the purpose of pain management. A Penchant for Pain Alleviation Renown's Special Procedures team offers a wide variety of pain management solutions that are uniquely tailored to each individual patient’s needs. With the help of a team of 14 attentive nurses, interventional radiology technologists and a surgical technician – plus a dedicated patient access representative ensuring everything goes smoothly behind-the-scenes – these lifechanging interventions include: Epidurals (including steroid epidurals) Nerve blocks Ablations Tenotomies Spinal cord stimulator trials Peripheral nerve stimulator trials The nurses on this specialized team guide patients before, during and after their procedures, making sure they are at ease throughout the entire process. Each nurse emulates both expertise and empathy to help light the path towards healing. “Before each procedure, we get the patient’s vitals, health history and work with the doctor to answer any questions they may have about what is going to happen in the procedure room,” said Michon Edgington, RN. “After they’re all done, they come back to me, and I make sure they are ready to go home by educating them on their discharge. Our goal is to get them back to their families very quickly.” “In the actual procedure room, we perform safety checks, do charting, prepare the sterile tray for the doctor and give medication for conscious sedations, all while consistently monitoring the patient and helping the doctor out along the way to help the procedure go well,” added Shannon Boelow, RN. This team’s dedicated imaging professionals harness expertise that goes beyond capturing images. Their skillful utilization of X-ray technology serves as a guide for doctors administering treatments for pain – and according to our own physicians, our imaging technologists are some of the best in the business. “Our X-ray skills here are specialized,” said Julie Smith, Imaging Lead. “Visually, the doctor needs to see what’s going on inside the body so they can accurately place needles and steroids. We all work together collectively and work with each doctor to accommodate their preferences, helping the treatments go much faster and minimizing the patient’s exposure to radiation.” Serving as the ideal representation of both precision and support, the surgical technician on this team is an important collaborator in the procedure room, helping to ensure the success of every interventional procedure with a meticulous eye for detail. “As the Special Procedures surgical technician, I get the room ready with all the necessary instruments, including making sure everything is sterile,” said Carrie Crow, Surgical Technician. “I enjoy keeping the team organized.” Overseeing it all are the physicians, who are eternally grateful for the team for the life-changing interventions they offer every day. “Our physicians are so phenomenal,” said Brittney Summerfield, Manager of Nursing. “They are very supportive and collaborative, and they always do the right thing. They have total confidence in us.” Seeing patients walk out of the hospital happy and healthy is a driving motivator for this team. Whether they had significant experience in pain management or were ready for a completely new challenge, each team member comes to work every day inspired to move mountains. “I had worked in pain management in other facilities, and I was extremely excited to come here and solely focus on pain,” said Jodi Eldridge, Supervisor of Special Procedures. “I enjoy seeing the patients so happy when they leave no longer in pain. I feel immediate gratification, because you truly feel like you’re doing something big for the patient. It’s very rewarding.” “I decided to come work here because I worked in the inpatient setting for a long time, and I was ready to see a different side of healthcare and provide a different type of care to our community; plus, my coworkers are the best,” added Lisa Dunnivant, RN. There’s no question that the realm of pain management is a delicate one – and there is no team better suited to take on that challenge than Special Procedures, working harmoniously to bring relief and a renewed sense of livelihood for every patient they serve. “Some people believe pain management is just all about pills, and that is simply not true,” said Carrie Crow. “Our procedures are yet another way to help them manage their pain and find relief.”
